Optimizing Early Enteral Nutrition in Severe Stroke

NCT ID: NCT02982668

Last Updated: 2021-11-04

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

TERMINATED

Clinical Phase

NA

Total Enrollment

306 participants

Study Classification

INTERVENTIONAL

Study Start Date

2017-01-31

Study Completion Date

2020-12-31

Brief Summary

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The purpose of this academic lead study is to explore the ideal nutritional support strategy for patient with acute severe stroke.

Detailed Description

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Of high mortality and morbidity, severe stroke is associated with devastating damages in neurologic, respiratory, circulatory and many other systems. The outcomes of patients with severe stroke depend largely on medical strategies on acute stage, especially on nutritional support management. Unfortunately, clinical evidence are sparse and the ideal initial feeding strategy remains disputable.

The IF-STROKE study aims to provide reliable data on the effects of modified full enteral feeding (target recruitment 200) and permissive underfeeding in patients with acute severe stroke (target recruitment 200) compared to full enteral feeding (target recruitment 200). Patients presenting with acute (\<72h) severe stroke (GCS ≦ 12 or NIHSS ≧ 11) and dysphagia (defined by Water Swallowing Test) will be randomly assigned to full enteral feeding, modified full enteral feeding, or permissive underfeeding treatment for 7 days.

Conditions

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Severe Stroke Acute Stroke Dysphagia

Keywords

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severe stroke Acute Stroke Enteral Feeding Mortality Disability Clinical trial

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

SUPPORTIVE_CARE

Blinding Strategy

SINGLE

Participants

Study Groups

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Full enteral feeding

The caloric goal of the first day is one-third of caloric requirements, the second day is half of caloric requirements, the third day is 70-100% and sustained for 1 week. Protein requirements are calculated at 1.2 to 1.5 g per kilogram of body weight per day.

Group Type ACTIVE_COMPARATOR

Initial enteral feeding

Intervention Type OTHER

Modified full enteral feeding

Consistent with full enteral feeding plan, preventively add metoclopramide or mosapride everyday to improve gastrointestinal (GI) motility.

Group Type EXPERIMENTAL

Initial enteral feeding

Intervention Type OTHER

metoclopramide or mosapride

Intervention Type DRUG

gastrointestinal (GI) motility improving

Permissive underfeeding

The caloric goal of the first day is one-third of caloric requirements, the second day is 40-60% and sustained for 1 week. Protein requirements are calculated at 1.2 to 1.5 g per kilogram of body weight per day.

Group Type EXPERIMENTAL

Initial enteral feeding

Intervention Type OTHER

Interventions

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Initial enteral feeding

Intervention Type OTHER

metoclopramide or mosapride

gastrointestinal (GI) motility improving

Intervention Type DRUG

Eligibility Criteria

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Inclusion Criteria

* Severe stroke occurred in 7 days.
* GCS ≤12 or NIHSS≥11.
* Any cases of profiles #3 through 5 in Water Swallowing Test or with disorder of consciousness.
* Plan to receive enteral feeding for at least 7 days.
* Informed consent.

Exclusion Criteria

* Gastrointestinal diseases before stroke, such as gastrointestinal resection, malabsorption,and irritable bowel syndrome.
* Brain death.
* Complicated with the disease which only have life expectancy \< 6 months in over 50% patients.
* After cardiac arrest.
* Received parenteral nutrition support.
* Pregnant woman.
* Concurrent severe hepatic or renal dysfunction。
* Unstable hemodynamics.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Tang-Du Hospital

OTHER

Sponsor Role collaborator

Xi'an Central Hospital

OTHER

Sponsor Role collaborator

Xi'an Gaoxin Hospital

OTHER

Sponsor Role collaborator

Yan'an University Affiliated Hospital

OTHER

Sponsor Role collaborator

940 Hospital of the People's Liberation Army Joint Logistic Support Force

OTHER

Sponsor Role collaborator

Xi'an No.3 Hospital

OTHER_GOV

Sponsor Role collaborator

First Affiliated Hospital Xi'an Jiaotong University

OTHER

Sponsor Role collaborator

Yulin No.1 Hospital

UNKNOWN

Sponsor Role collaborator

First People's Hospital of Xianyang

OTHER

Sponsor Role collaborator

Tongchuan Mining Hospital

UNKNOWN

Sponsor Role collaborator

The PLA General Hospital of Xinjiang

UNKNOWN

Sponsor Role collaborator

Tongchuan People's Hospital

UNKNOWN

Sponsor Role collaborator

Yulin No.2 Hospital

OTHER

Sponsor Role collaborator

Ankang Central Hospital

OTHER

Sponsor Role collaborator

Xijing Hospital

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Wen Jiang, PhD

Role: STUDY_DIRECTOR

Department of Neurology, Xijing Hospital, Fourth Military Medical University

Locations

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Xijing Hospital

Xi'an, Shaanxi, China

Site Status

Tangdu Hospital

Xi'an, Shaanxi, China

Site Status

The First Affiliated Hospital of Xi'an Jiaotong University,

Xi'an, Shaanxi, China

Site Status

Yulin No.2 Hospital

Yunlin, Shaanxi, China

Site Status

Countries

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China

References

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Wirth R, Smoliner C, Jager M, Warnecke T, Leischker AH, Dziewas R; DGEM Steering Committee*. Guideline clinical nutrition in patients with stroke. Exp Transl Stroke Med. 2013 Dec 1;5(1):14. doi: 10.1186/2040-7378-5-14.

Reference Type BACKGROUND
PMID: 24289189 (View on PubMed)

McClave SA, Taylor BE, Martindale RG, Warren MM, Johnson DR, Braunschweig C, McCarthy MS, Davanos E, Rice TW, Cresci GA, Gervasio JM, Sacks GS, Roberts PR, Compher C; Society of Critical Care Medicine; American Society for Parenteral and Enteral Nutrition. Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). JPEN J Parenter Enteral Nutr. 2016 Feb;40(2):159-211. doi: 10.1177/0148607115621863. No abstract available.

Reference Type BACKGROUND
PMID: 26773077 (View on PubMed)

FOOD Trial Collaboration. Poor nutritional status on admission predicts poor outcomes after stroke: observational data from the FOOD trial. Stroke. 2003 Jun;34(6):1450-6. doi: 10.1161/01.STR.0000074037.49197.8C. Epub 2003 May 15.

Reference Type RESULT
PMID: 12750536 (View on PubMed)

Ukleja A. Altered GI motility in critically Ill patients: current understanding of pathophysiology, clinical impact, and diagnostic approach. Nutr Clin Pract. 2010 Feb;25(1):16-25. doi: 10.1177/0884533609357568.

Reference Type RESULT
PMID: 20130154 (View on PubMed)

Dennis MS, Lewis SC, Warlow C; FOOD Trial Collaboration. Effect of timing and method of enteral tube feeding for dysphagic stroke patients (FOOD): a multicentre randomised controlled trial. Lancet. 2005 Feb 26-Mar 4;365(9461):764-72. doi: 10.1016/S0140-6736(05)17983-5.

Reference Type RESULT
PMID: 15733717 (View on PubMed)

Heyland DK, Stephens KE, Day AG, McClave SA. The success of enteral nutrition and ICU-acquired infections: a multicenter observational study. Clin Nutr. 2011 Apr;30(2):148-55. doi: 10.1016/j.clnu.2010.09.011. Epub 2010 Oct 25.

Reference Type RESULT
PMID: 20971534 (View on PubMed)

Jie B, Jiang ZM, Nolan MT, Zhu SN, Yu K, Kondrup J. Impact of preoperative nutritional support on clinical outcome in abdominal surgical patients at nutritional risk. Nutrition. 2012 Oct;28(10):1022-7. doi: 10.1016/j.nut.2012.01.017. Epub 2012 Jun 5.

Reference Type RESULT
PMID: 22673593 (View on PubMed)

National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network; Rice TW, Wheeler AP, Thompson BT, Steingrub J, Hite RD, Moss M, Morris A, Dong N, Rock P. Initial trophic vs full enteral feeding in patients with acute lung injury: the EDEN randomized trial. JAMA. 2012 Feb 22;307(8):795-803. doi: 10.1001/jama.2012.137. Epub 2012 Feb 5.

Reference Type RESULT
PMID: 22307571 (View on PubMed)

Permissive Underfeeding or Standard Enteral Feeding in Critically Ill Adults. N Engl J Med. 2015 Sep 24;373(13):1281. doi: 10.1056/NEJMx150028. No abstract available.

Reference Type RESULT
PMID: 26398094 (View on PubMed)

Sakai K, Niimi M, Momosaki R, Hoshino E, Yoneoka D, Nakayama E, Masuoka K, Maeda T, Takahashi N, Sakata N. Nutritional therapy for reducing disability and improving activities of daily living in people after stroke. Cochrane Database Syst Rev. 2024 Aug 15;8(8):CD014852. doi: 10.1002/14651858.CD014852.pub2.

Reference Type DERIVED
PMID: 39145517 (View on PubMed)

Zhao J, Yuan F, Song C, Yin R, Chang M, Zhang W, Zhang B, Yu L, Jia Y, Ma Y, Song Y, Wang C, Song C, Wang X, Shang L, Yang F, Jiang W; OPENS Trial Investigators. Safety and efficacy of three enteral feeding strategies in patients with severe stroke in China (OPENS): a multicentre, prospective, randomised, open-label, blinded-endpoint trial. Lancet Neurol. 2022 Apr;21(4):319-328. doi: 10.1016/S1474-4422(22)00010-2. Epub 2022 Feb 24.

Reference Type DERIVED
PMID: 35219379 (View on PubMed)

Yuan F, Yang F, Zhang W, Jia Y, Ma Y, Qu Y, Wang X, Huo K, Wang C, Yuan X, Song C, Zhang B, Jiang W; OPENS study group. Optimizing early enteral nutrition in severe stroke (OPENS): protocol for a multicentre randomized controlled trial. BMC Neurol. 2019 Feb 12;19(1):24. doi: 10.1186/s12883-019-1253-2.

Reference Type DERIVED
PMID: 30755171 (View on PubMed)

Other Identifiers

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KY20162086-2

Identifier Type: -

Identifier Source: org_study_id